Provider Demographics
NPI:1881109155
Name:GOLDEN OPTICAL
Entity type:Organization
Organization Name:GOLDEN OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:754-400-7092
Mailing Address - Street 1:15999 PINES BLVD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1232
Mailing Address - Country:US
Mailing Address - Phone:754-400-7092
Mailing Address - Fax:954-404-7197
Practice Address - Street 1:15999 PINES BLVD UNIT 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1232
Practice Address - Country:US
Practice Address - Phone:754-400-7092
Practice Address - Fax:954-404-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOE2405332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies